19/03/2010 by David Slade.

The use of data cable and infrastructures within healthcare premises to carry information to and from the bedhead opens up the possibility of using the data cable for other facilities.Where data cables (for example Cat 5e, fibre-optic) are used to carry communication and control information to and from the bedhead, or other nursing position, in support of IP (Internet protocol)-based nurse call, patient/nurse speech, telephony, Internet and entertainment services etc, these should be capable of fully supporting the required computer network technologies as directed by the healthcare facility’s IT manager. Examples of computer network technologies include 10Base-T, 100Base-T, 1000Base-T (Gigabit) Ethernet, and Token Ring.

Utilising a common data highway may, however, impact upon business and clinical risk. Therefore, careful consideration should be given to the extent to which provisions are incorporated into the system to ensure adequate reliability and resilience of the various services so as to minimise such risks.

Data cables used for bedhead services will normally be independent of the main healthcare facility’s primary IT network (unless otherwise directed by the healthcare facility’s IT manager), but they will interface with the network at appropriate strategic points.

Relevant protocols and test procedures to achieve the required functional transparency and resilience should be agreed between the bedhead services’ equipment supplier(s) and healthcare facility’s IT manager before the interface(s) is/are installed.

Entertainment (radio and TV) and communication (telephony and Internet access) services may be provided through a low-energy digital device at each bedhead. Such devices should not be used as the primary control for any patient and staff calls, but should be capable of being used for patient health education and for menu-ordering in addition to other services as described in the list at the bottom of this page. When required, the device should also be capable of being interfaced with the hospital information systems and IT network for use by hospital staff and to reduce installation and maintenance costs.

Prior to installation, all facilities that utilise common data infrastructure systems should be adequately assessed with regard to their potential effect on other hospital systems, particularly in respect of any capacity, security and safety implications. Suitable provisions should be incorporated to ensure that such systems operate safely and reliably, with no unwanted interference being incurred sufficient to cause operational difficulties between systems.

Appropriate input and output interfaces should be provided as necessary to ensure a fully operational system in compliance with manufacturers’ requirements and with functionality as specified elsewhere in the project specification.

Once installed, the capacity of a data cable is potentially considerable, so expansion of facilities in the ward or nursing area becomes possible with the appropriate input and output interfaces.

Some features that may be developed are:

• Bed status: to indicate whether the bed is occupied, vacant, in the course of preparation or out of commission.
• Patient monitoring: to allow the output signals from medical apparatus to be multiplexed onto the data line. This may take the form of a simple on/off medical alarm or a constant reporting of varying analogue signals to indicate a changing medical condition.
• Menu selection: to enable the patient to view and select their choice of meal.
• Patient details: to enable the entry of a patient’s name, address and all relevant personal information at the bedside.
• Medication requirements: to display all medical details to the nurse or doctor at the bedhead.
• Patient entertainment: Internet etc.
• Communication: Voice over Internet Protocol (VoIP) telephony.
• Patient administration systems: to provide full clinical access to the healthcare facility’s clinical data IT network at the bedside.
• Door access and security: to allow the nurse-call system to be integrated with CCTV and door-access systems.
• Clinical report displays: to enable laboratory results, X-rays and computed tomography (CT) scans to be displayed to clinical staff at the bedside.
• Administration of drugs: to facilitate the accurate discharging and recording of drugs administered at the bedside.

Posted in Patient details, Medication requirements, Meal selection, Patient monitoring, electronic patient record (EPR), Bed status, Patient entertainment, door-access systems, 10BASE-T, 1000 BASE-T, nurse-call, bedhead services, Administration of drugs, Clinical report displays, VoIP | 1 Comment »

18/03/2010 by David Slade.

Patient’s calling devices

Patient-to-nurse calling devices should have a tactile feel. The push-button or pull-ring should be easily recognised by its colour (normally amber) and by a nurse symbol indelibly engraved/printed on or alongside the device. Examples of typical nurse symbols are shown in the diagram below.

Typical layout of patient handset with example of symbols

The device should be easy to operate by the patient irrespective of whether he/she is ambulant, disabled or confined to bed.

Patient-to-nurse calling devices are normally of the push-button type; however, different designs and configurations should be available to suit individual patient condition requirements. These should be capable of utilising a common basesocket connector unit to allow flexibility in use at each call point.

For ease of location at night, the hand unit should be permanently back-lit, but not so brightly that it could be confused with the reassurance lamp.

A reassurance lamp in the form of a light-emitting diode (LED) should be positioned adjacent to, or should be integrated within, the call device.

The voltage potential difference between any two points, including earth, likely to be experienced by patients or persons associated with the call unit or its cable should not exceed that which applies to medical equipment described in the MEIGaN regulations either under normal or fault conditions. The nurse-call circuit should be automatically monitored so that a break in the cable or withdrawal of the plug will initiate a call.

Further information:

MEIGaN

Wall- or trunking-mounted push-button

The push-button should be large enough and easily recognisable and suitable for all areas of a healthcare facility frequented by ambulant patients or where it may be intended to be used. Associated with the push-button – either integrally or alongside – a reassurance lamp should be fitted.

Hand-held nurse-call-only unit

A hand-held unit used solely for patient–nurse call purposes should consist of a push-button attached to a fixed unit by means of a suitable cable plug/ socket connector. The push-button should be large and easily recognisable, with a reassurance lamp in the form of an LED fitted either integrally or alongside.

The push-button should be permanently illuminated to a level sufficient to allow easy location in the dark, but should not be so bright as to be confused with the nurse-call reassurance lamp.

The unit should be ergonomically designed, with a flexible lightweight cable of sufficient length to enable patients to activate a call from the bed or whilst sitting in a bedside chair or nursing area etc. The means of attachment at both ends of the cable should be in the form of an effective strain-relief device in order to minimise risk of cable failure. The plug attachment to the base unit should be of a pattern that will disengage from the wall socket when strain is applied to the cable from any angle without damage to plug, socket or cable. Where the same plug and socket is used for a patient handset as an alternative to a call-only unit, the circuitry of the call-only unit should be compatible with that of the handset so that the socket can be used for either.

The control of infection should also be considered in the design and manufacture of the patient handset unit. It should be designed with an appropriate IP rating (see BS EN 60529) so that the unit can withstand submersion in various liquids.

It should also be designed to allow patients with a range of disabilities not only to operate the unit but also to understand the functions of the unit.

Some means of attaching the call-only unit securely to the bedclothes or the patient’s clothes should be available, but it should be so designed that any undue force will allow the clip to disengage without tearing the materials.

A parking clip or bracket should be provided to allow the unit to be stored on the wall or locker when not in use.

Pull-cord unit

In showers, bathrooms and toilets, the patientcalling device is normally a ceiling-mounted pullcord unit with pull rings as described in Part M of the Building Regulations – namely, coloured red, located as close to the wall as possible, and having two red 50 mm diameter bangles (or similar) set at different heights. It is important that the pull-cord is easily recognised as the calling device and cannot be confused with a light switch. The pull-cord unit should provide reassurance that the system has operated. The switch should have a momentary action to activate a call. Use of pull-cords within mental illness units needs careful consideration to avoid potential ligature points, and in any case, the cord should have a low breaking strain.

Other call units

Pneumatically-operated call units can be used for patients who are unable to use their hands. The unit comprises an air bulb and connecting tube, terminating in an air-velocity-operated switch that is integral with the wall unit.

Other forms of call unit that facilitate operation by disabled patients should be considered if these provide enhanced and more efficient use. The design and manufacture of such units should be sufficiently robust to provide a safe and reliable service, and their method of operation should be compatible with the remainder of the patient call system.

Posted in nurse-call, Patient's calling devices, MEIGaN - Medical Electrical Installation, Healthcare | No Comments »